Episiotomy increases perineal laceration length in primiparous women

Nager, Charles W.; Helliwell, Jason P.

doi:10.1067/mob.2001.116095

Cited by 52 publications

(38 citation statements)

References 10 publications

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“…The study was prospective but not randomized, and it is possible that the midwives decided to suture women with more severe second-degree lacerations. The use of a defined methodology, such as that developed by Nager 27 for measuring the depth of second-degree lacerations, would allow for comparisons that include laceration depth to determine whether functional benefits exist in women with deeper second-degree lacerations. Finally, women may have had sustained pelvic floor damage from a previous delivery and not from the present delivery.…”

Section: Discussionmentioning

confidence: 99%

Do Unsutured Second-Degree Perineal Lacerations Affect Postpartum Functional Outcomes?

Leeman¹,

Rogers²,

Greulich³

et al. 2007

The Journal of the American Board of Family Medicine

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Background:To compare the postpartum pelvic floor function of women with sutured second-degree perineal lacerations, unsutured second-degree perineal lacerations, and intact perineums.Methods: A prospective cohort of nurse-midwifery patients consented to mapping of genital trauma at birth and an assessment of postpartum pelvic floor outcomes. Women completed validated questionnaires for perineal pain and urinary and anal incontinence at 12 weeks postpartum and underwent physical examination to assess pelvic floor strength and anatomy at 6 weeks postpartum.Results: One hundred seventy-two of 212 (80%) eligible women provided follow-up assessment data at 6 or 12 weeks postpartum. Women with an intact perineum (n ‫؍‬ 89) used fewer analgesics (P < .002) and had lower pain scores at the time of hospital discharge than women with second-degree lacerations (sutured, n ‫؍‬ 46; unsutured, n ‫؍‬ 37; intact, n ‫؍‬ 89) (P < .02). The sutured group was more likely to use analgesics (52%) than the unsutured (35%) or intact (23%) groups at time of hospital discharge (P < .002), although pain scores were not different between sutured and unsutured groups. Postpartum reports of urinary or anal incontinence, sexual inactivity, or sexual function scores did not vary between groups. Weak pelvic floor exercise strength was more common among the women with second-degree lacerations compared with women with an intact perineum (53% vs. 28%; P ‫؍‬ .03) but did not differ between sutured (58%) and unsutured (47%) groups (P ‫؍‬ not significant). Likewise, perineal body or genital hiatus measurements did not vary between groups (P ‫؍‬ not significant).Conclusions :

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Section: Discussionmentioning

confidence: 99%

Do Unsutured Second-Degree Perineal Lacerations Affect Postpartum Functional Outcomes?

Leeman¹,

Rogers²,

Greulich³

et al. 2007

The Journal of the American Board of Family Medicine

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“…Spontaneous posterior perineal lacerations are common during vaginal delivery particularly in nulliparous women causing either occult or recognized anal sphincter disruption with subsequent fecal incontinence in 50% of cases [1][2][3][4][5][6][7][8]. Perineal trauma also contributes to the development of pelvic organ prolapse (POP) and urodynamic stress incontinence as a result of injury to the pelvic floor [1][2][3][4][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

“…Perineal trauma also contributes to the development of pelvic organ prolapse (POP) and urodynamic stress incontinence as a result of injury to the pelvic floor [1][2][3][4][9][10][11][12]. Episiotomy has been performed to protect against these complications [9,10,[13][14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

“…However, the value of this procedure is increasingly questioned because of the associated postoperative morbidity in the absence of clearly defined evidence for efficacy [13][14][15][16][17][18]. Paradoxically, episiotomy, particularly if median, is associated with occurrence of posterior perineal tears involving the anal sphincter in most [1,3,5,[12][13][14][15][16][17][19][20][21][22] but not all [2,[6][7][8]23] studies. Episiotomy also decreases perineal muscle strength and performance during the postpartum period more than does spontaneous posterior perineal laceration because of greater tissue disruption [4,9,16,24].…”

Section: Introductionmentioning

confidence: 99%

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Determinants of the length of episiotomy or spontaneous posterior perineal lacerations during vaginal birth

et al. 2005

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The objective of this study was to measure the length of episiotomy or spontaneous posterior perineal laceration and their relationship to perineal measurements and obstetric variables. The length of the perineum and genital hiatus and vertical length of episiotomy or posterior perineal tears were measured in 114 consecutive parturients with spontaneous singleton term deliveries. Seventy-four (65%) women underwent episiotomy while 40 (35%) sustained spontaneous posterior tears. Perineal or genital hiatus length was significantly correlated to episiotomy (r=0.34, p=0.003) or laceration (r=0.37, p=0.02) length, respectively. This association was significant (p=0.001) in a generalized linear model with duration of second stage of labor (p=0.005), degree of tear (p=0), and parity (p=0). Perineal length was significantly related to maternal age (p=0.036) and weight (p=0.037) and hiatal length (p=0). Short perineum and genital hiatus, long second stage of labor, and low parity are associated with longer posterior perineal injury.

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“…Es gibt auch Hinweise, wonach ein direktes Gewebetrauma bei der Entbindung schädliche Auswirkungen auf die Beckenbodenfunktion haben kann [29]. Es wird angenommen, dass Einrisse am Beckenboden sowie Beeinträchtigungen der Beckenbodeninnervation primär bei der ersten Entbindung auftreten [30,31], wobei geburtshilfliche Maßnahmen wie Saugglocke, Geburtszange und Dammschnitt das Risiko noch weiter erhö-hen [30][31][32]. In der vorliegenden Studie fand sich eine starke unabhängige Assoziation zwischen der Anzahl vaginaler Entbindungen und Vaginalprolaps-Operationen (s. Tabelle 3).…”

Section: Diskussionunclassified

Genitalprolaps und Harninkontinenz bei Frauen mit operativ behandeltem Rektumprolaps

Altman

Zetterström²,

Schultz

et al. 2006

Coloproctol

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ZusammenfassungFragestellung: Ziel dieser Studie war es, die Prävalenz von Genitalprolaps-Operationen und Harninkontinenz bei Patientinnen, die wegen eines Rektumprolaps operiert worden waren, im Vergleich zu einer entsprechenden Kontrollgruppe ohne Rektumprolaps zu untersuchen.Patienten und Methodik: 52 Patientinnen mit Rektumprolaps-Operationen in der Vorgeschichte sowie 200 willkürlich ausgewählte, alters-und geschlechtsangepasste Kontrollpersonen ohne Rektumprolaps erhielten einen ausführlichen Gesundheitsfragebogen.Ergebnisse: Die Rücklaufquote betrug in der Patientinnengruppe 48 von 52 (92%) und in der Kontrollgruppe 165 von 200 (82%). Ein Rektumprolaps war mit einem gesteigerten Operationsrisiko wegen eines Uterusprolaps (Odds-Ratio = 3,1; 95%-Konfidenzintervall = 1,4-6,9) und eines Vaginalprolaps (Odds-Ratio = 3,2; 95%-Konfidenzintervall = 1,3-7,8) assoziiert. Das mittlere Alter bei einer Hysterektomie wegen Uterusprolaps betrug 54,7 Jahre in der Patientinnengruppe, verglichen mit 62,6 Jahren in der Kontrollgruppe (p < 0,01). Das mittlere Alter bei Vaginalprolaps-Operation betrug 60,2 Jahre in der Patientinnengruppe, verglichen mit 66,6 Jahren in der Kontrollgruppe (p < 0,05). Es fanden sich keine signifikanten Unterschiede zwischen den Gruppen bezüglich einer höheren Prävalenz oder des Alters beim ersten Auftreten einer Harninkontinenz.Schlussfolgerung: Die Ergebnisse zeigen einen starken Zusammenhang zwischen einer rektalen und genitalen Prolapsoperation. Dies legt nahe, dass der Diagnose eines Rektumprolaps, der operiert werden soll, eine multidisziplinäre Beckenboden-Untersuchung folgen muss.

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Episiotomy increases perineal laceration length in primiparous women

Cited by 52 publications

References 10 publications

Do Unsutured Second-Degree Perineal Lacerations Affect Postpartum Functional Outcomes?

Do Unsutured Second-Degree Perineal Lacerations Affect Postpartum Functional Outcomes?

Determinants of the length of episiotomy or spontaneous posterior perineal lacerations during vaginal birth

Genitalprolaps und Harninkontinenz bei Frauen mit operativ behandeltem Rektumprolaps

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